Rural small animal practices invisible long enough
Those who analyze the economics of this profession are usually not members of the profession.
They represent associations and publications that serve this profession as well as market research companies hired to analyze and create viable databases for their clients-usually drug companies. Most of this work is done with surveys and telephone interviews.
They are eager to categorize veterinarians in order to better understand the profession for a variety of reasons. All of these people, regardless of who they represent are, no doubt, trying to do a good job and the effort put forward is certainly valid.Among the things they analyze are the buying preferences and professional and personal attitudes that may help shape a positive outcome for the practices and veterinarians they serve- usually in an economic sense. They do so based on certain criteria that seem to make sense to them. These criteria often include:
Most significant divisionUnfortunately, these surveys and interviews almost always fail to differentiate practices based on the most significant economic and culture division that occurs in this country-rural versus suburban.
Rural practices are different. If you practice any type of veterinary medicine in a rural area for more than a few hours you will know that the attitudes and preferences of clients differ significantly from their suburban and urban cohorts. Unfortunately, those who have spent their entire practice life within the suburban belt of a large city have very little insight into daily practice in the rural area. No one could expect them to know.
I have practiced in both worlds and would like to speak to this difference by letting a recently hired assistant who had worked in two suburban practices before coming to us tell you her story in her own words.
An interview with Kim Kennedy, veterinary assistant
Is this the first practice that you have worked in that is in a primarily rural area?
The practices that you worked in before, were they in suburban areas?
What differences did you note within the first week?
These are very different clients. Clients are friendlier but more interested in dollar issues. The suburban practices do more and are allowed to do more testing. The suburban practices have more monitoring equipment for anesthesia and do much more complete monitoring of patients under each anesthetic. This is primarily because they seem not as constrained money-wise. We monitor differently here in order to try to achieve the same level of care.
Are there issues related to money for clients who seem different? Explain.
Many more clients here are on a budget. I am doing many more estimates here. When clients are unaware of the cost beforehand they get upset when they get the bill even if they never asked for a quote.
Does there seem to be more estimating and calls for pricing in this practice?
Much more. Before I was only estimating costly procedures, such as orthopedics. Here, we get calls daily checking on prices for routine things.
In spite of this, is the quality of practice diminished for the remaining clients who want the very best medicine?
The quality of care here is superb... For those clients who do want the best approach, it is much easier for them to get involved procedures done quickly than in my previous practices. This is because there is a shorter waiting period for higher end care because the remaining lower end clients opt out or decline the recommended treatment plans. Therefore, in general, I believe the lower level clients do not diminish the level of care for the better clients.
Do you think that the practice you are in now offers quality medicine in spite of the economic obstacles?
I believe they offer quality care. They find ways to work around the economic obstacles, be it by working with the people or doing charity work.
A change down on the farmFor the past few decades the livestock industry has been consolidating and for most rural areas this has dramatically changed the manner in which rural practices serve these communities. This is a complex issue but the big trend has been for these practices to change to a small animal focus whether they wanted to or not. This means that the majority of practices in the rural areas are now primarily small animal. As for myself, my practice gave up large animal practice more than 20 years ago.
It is transparent to those in the rural areas that most of the publications and associations that serve practices in this country assume that the tastes and preferences of our clients reflect those of the suburban environment-after all these associations and publications are situated within that environment themselves. In addition, much of the advice given by consultants seems to be geared to this segment of our profession. The rural practices, particularly small animal practices that now predominate in the rural areas, are invisible to the profession and to a lot of the people who could better serve it.
What is rural? What is suburban?Unfortunately this is not well defined and is subjective depending on the source.
Since these are dynamic environments they are hard to quantify. But just for simplicity I would like to define rural practice as any practice greater than 50 miles from an urban core or suburban belt of at least a million people. That means that practices in large towns of even 100,000 are for the most part still influenced by their mostly rural surroundings and are essentially rural practices. On the suburban side, at least half of this country's population is living within these urban/suburban areas and it is growing.
The number of veterinarians remaining in the rural environment is unknown because of the very reason I am writing this article. However, it can safely be assumed that at least half of the veterinarians in the country live in these areas and it is likely that most are in solo practice. Of interest is that the urban core probably contains many veterinarians with clients whose financial limitations closely reflect their rural counterparts.
The suburban viewpointWhen I was in practice in Los Angeles more than 20 years ago, most of my blue collar clients would spend their last dime on their pets. These clients made their pets a priority with their discretionary dollars. These suburbanites were almost always gainfully employed and their pets were always part of their families. These were the vast majority of my clients. Accounts receivable were not usually any problem. In addition, I had some very wealthy clients. Many had purebred dogs and cats and spent their financial resources accordingly. Clients were quite demanding at times but I was also able to practice at a level that was very satisfying professionally. I was not a city person and moved home to the rural area.
When I started my practice in a mostly rural area it became obvious that developing a high quality practice would eventually be within reach, but that the time to develop this kind of practice would take time and I would need to educate clients beyond what had been necessary in Los Angeles.
Now when I meet other veterinarians from the suburbs and talk about clients and their willingness to part with their hard earned cash for more involved procedures it becomes obvious that they have little understanding regarding what we are up against in rural areas.
The paradigm solution for suburban practice success seems to revolve around finding the right employees and then charging enough money to achieve economic objective(s). In other words, determine your target net income and raise your prices immediately in order to hit that target in a specified time. This is a recipe that can only work where there is a complexly inelastic demand for veterinary services.
I am sure that in many cases this will work for the suburban practitioner. It should be pointed out that a rural small animal practice can be very successful financially as well. However, you will have to be creative (and firm) with your fee schedule while at the same time being able to work with and through economic limitations. This takes a while to learn.